Doppler study of middle cerebral artery and umbilical artery in biometrically suspected intra uterine growth restricted pregnancies

Background: Intra uterine growth restricted (IUGR) is when the expected foetal weight is less than 10th percentile for gestational age. The hemodynamics of the feotus takes into account both the umbilical-placental and cerebral vascular beds. Underlying etiology that results in the failure of a foetus to attain its expected growth may vary. However the final infliction is via uteroplacental insufficiency. It is highlighted that inadequate uteroplacental perfusion is the main and primary pathology in growth restriction resulting in an increased umbilical artery impedance. Following this step are the changes in the middle cerebral artery (MCA) which categorically set in as a secondary phenomenon.Methods: Duplex Doppler Sonography is a reliable, non- invasive and rapid diagnostic technique in IUGR patients. Grey scale findings together with colour Doppler characteristics help in the qualitative as well as quantitative evaluation of the Uteroplacental and Fetoplacental circulation. Hence ultrasonography (USG) has become the most widely used, standard and simple way of detecting and confirming IUGR. Ultrasound biometry is the gold standard for assessment of foetal size. Various criteria are used to label a feotus growth restricted; foetal weight less than 10th percentile for gestational age is mostly widely accepted criterion. Others like elevated HC/AC ratio, elevated FL/AC ratio, and presence of oligohydramnios without ruptured membranes, presence of advanced placental grade can also be used for improving the accuracy of diagnosis. After establishing the diagnosis of IUGR, Doppler imaging becomes a valuable investigating method for monitoring the pregnancy because it provides information about the hemodynamic status of the feotus. Uteroplacental system evaluation takes into account the flow pattern of uterine artery, reflecting any underlying Uteroplacental vascular ischemia. Umbilical artery Doppler waveforms reflect the status of the fetoplacental circulation and any underlying placental insufficiency.Results: Fourteen cases showed absent umbilical artery end diastolic flow and four patients showed reversal of end diastolic flow.: Twenty two patients showed elevated PI. Adverse perinatal outcome was observed in all patients with absent and reversal of end diastolic flow. Out of the twenty two with elevated PI fifteen showed adverse outcome. Thirty six cases showed low MCA PI and six showed a pseudonormalization. A cerebro -placental ratio of < 1.08 was observed in 16 patients, it was calculated in only those pregnancies that showed forward diastolic flow in umbilical artery (n= 22). Fifteen of them showed adverse perinatal outcome.Conclusions: Doppler imaging is of value for monitoring pregnancies complicated with IUGR because it can provide indirect evidence of foetal compromise and is known to improve outcome of high risk pregnancies. Doppler evaluation is complementary to all other surveillance modalities. Because the changes in umbilical, uterine & MCA strongly correlate with pregnancy outcome in growth restricted foetuses the use of foetal biometry & Doppler examination is recommended in all cases of suspected IUGR cases

Median arcuate ligament syndrome: A diagnosis on CT abdominal angiography in cases of non-specific abdominal pain

The median arcuate ligament syndrome (or celiac artery compression syndrome) is a rare disorder characterized by post-prandial intestinal angina due to insufficient blood supply to the gastrointestinal organs. This syndrome was first described in the year 1963 by Harjola, where compression of the celiac artery by the median arcuate ligament was noted. Otherwise, this syndrome is a source of controversy in the literature due to its high incidence in otherwise asymptomatic individuals. Various radiological imaging modalities with computed tomography (CT) angiography, the most widely used modality, help in diagnosing this syndrome that can then be surgically corrected. This case report aims at the CT angiography findings in symptomatic patients

Neurofibromatosis 2

Neurofibromatosis 2 is a rare autosomal dominant neurocutaneous disorder classically characterized by bilateral acoustic schwannomas. Multiple other central, as well as peripheral central nervous system neoplasms as meningiomas and ependymomas, are also associated. We present here a case of 18-year-old female with bilateral hearing loss. Magnetic resonance imaging (MRI) of the brain and spine showed multiple intracranial and intra-spinal neoplasms. Bilateral large acoustic and other cranial nerve schwannomas, along with multiple spinal neurofibromas were present. Based on these MRI findings a diagnosis of neurofibromatosis was made

Rapid magnetic resonance imaging protocol for detecting femoral head avascular necrosis: A case series-it′s utility in the general population in developing countries

Introduction: Osteonecrosis of the femoral head is an increasing cause of musculoskeletal disability, common among the younger population, between the third and fifth decade of life, affecting mainly men, thereby requiring prompt diagnosis and early intervention. Aims and Objectives: The aim was to formulate a limited magnetic resonance imaging (MRI) examination protocol for detection of avascular necrosis (AVN) in clinically suspected cases that can be performed rapidly and will be inexpensive. Materials and Methods: Forty-five patients suspected clinically and or on conventional radiography for AVN of the femoral head were referred for MRI hip. MRI hip was done on 1.5 T Siemens Avanto. Of 45, 36 were detected to have AVN (total 58 hips), whereas 9 did not have AVN on MRI. Initially, coronal T1-weighted image (T1WI) sequence was obtained as limited MRI protocol, followed by complete MRI examination. Results: Maximum patients belonged to age group 31-40 (30.5%). 32 (88.88%) patients were males and 4 (11.11%) were females. Bilateral AVN was detected in 44 (61.1%) and unilateral in 14 patients (38.8%). Pre collapsed stage (Stages I and II) was detected in 18 hips (31.03%), collapsed stage (Stages III and IV) was detected in 40 hips (68.9%). Peripheral low-intensity rim was seen on T1WI in all 58 cases of AVN. Double line sign on T2-weighted image was seen in 33/58 (56.8%). Conclusion: Our study concluded that coronal T1W sequence is an easy, rapid and cost-effective method of detecting unilateral or bilateral AVN